Management of anaphylaxis in the dental practice

Anaphylaxis is a life-threatening emergency that can occur in the dental practice (Müller et al, 2008). The recent death of a patient, who suffered an anaphylactic reaction and died in a dental practice in Brighton following treatment with Corsodyl mouthwash (Box 1) (BBC News, 2013), stresses the need for all dental care professionals to be able to recognise and effectively manage anaphylaxis. The Resuscitation Council (UK) (2012a) and the National Institute for Health and Care Excellence (NICE, 2011) have published guidelines for the management of anaphylaxis.

A young woman died after suffering a fatal reaction to mouthwash while she was sitting in the dentist's chair, an inquest heard. The patient, aged 30, was undergoing routine treatment and was not under anaesthetic when she went into shock. She complained of feeling hot and having an itchy leg and back moments before collapsing and sliding of the chair on to the surgery floor. Her dentist missed the warning signs that the patient was suffering an anaphylactic shock, the inquest heard, and within a few minutes she was dead. Tests later revealed the patient, who had severe learning difficulties, had suffered an anaphylactic reaction to a chemical called chlorhexidine contained in the mouthwash, which is commonly prescribed for gum disease. The patient had gone blue, had no pulse and had stopped breathing. She should have been given a dose of adrenaline, oxygen and chest compressions as soon as possible.